CHAPTER 4: COMMUNITY AND HOME HEALTH NURSING

MULTIPLE CHOICE 1. The largest percentage of community health nurses work in: a. state and local health departments c. school health nursing b. U.S. Department of Veterans Affairs d. home health ANS: D
Feedback A B C D

Incorrect: About one in four community health nurses work in local and state health departments and community health centers. Incorrect: Not applicable. Incorrect: Community health nurses work in school health, occupational health, hospice, and other settings, representing about one in four. Correct: The majority of community health nurses work in home health. REF: p. 85 OBJ: Cognitive Level: Knowledge

PTS: 1

2. Which of the following best represents the focus of the community health nurse? a. health promotion and disease prevention b. curing people who are chronically ill c. working with those who do not have health insurance d. optimal functioning of the family ANS: A
Feedback A B C D

Correct: The community health nurse has a focus on health promotion and disease prevention. Incorrect: The community health nurse does not cure people who are chronically ill. The nurse promotes health in order to prevent chronic illness. Incorrect: Although the community health nurse may work with those who are uninsured, this option does not best represent the focus. Incorrect: The community health nurse is not focused upon the optimal functioning of the family, but of the community or a population as a whole. REF: p. 86 OBJ: Cognitive Level: Comprehension

PTS: 1

3. While community health nurses focus on the individual or the family, which of the following do they also have as their final objective? a. the well-being of the extended family c. the financial well-being of the family b. the well-being of the community d. the well-being of the chronically ill ANS: B
Feedback A B C

Incorrect: The final objective of the community health nurse is not the well-being of the extended family. Correct: The well-being of the community as a whole is the final objective for community health nursing. Incorrect: The final objective of the community health nurse is not the financial well-

being of the family. Incorrect: The final objective of the community health nurse is not the well-being of the chronically ill. REF: p. 86 OBJ: Cognitive Level: Knowledge

PTS: 1

4. The community health nurse is coordinating all the services needed by child who has a chronic illness and is staying at home: physical therapy, tutoring, occupational therapy, respite care, as well as financial resources for the caregivers. This activity best represents which of the following legitimate roles for the community health nurse? a. case manager c. collaborator b. advocate d. consultant ANS: A
Feedback A B C D

Correct: The community health nursing role as case manager involves developing and coordinating services for a selected client and family. Incorrect: The role of advocate involves promoting client needs and desires. Incorrect: The role of collaborator involves working with other nurses, social services, judicial systems, and school systems to ensure holistic care. Incorrect: The role of consultant involves the community health nurse as an expert able to propose solutions for identified problems. REF: p. 86 OBJ: Cognitive Level: Comprehension

PTS: 1

5. You are the community health nurse working with a single mother who has small children. You have helped the mother get on the Women, Infants, and Children (WIC) program. She receives coupons from this program to get food for her children, but she often fails to use the coupons, saying she is embarrassed to take charity. Which of the following responses from you would most likely succeed in getting her to use the coupons? a. Its really not charity. You have paid taxes and will pay more taxes some day when you have a job. b. If you dont take the help, someone else less deserving will. c. If I were in your shoes, I would use the coupons and be glad of having them. d. It is important to give your children nutritious meals so they will grow, and this is a way to provide them. ANS: D
Feedback A B C D

Incorrect: Telling her it is not charity when she feels it is charity is ignoring her feelings and is ineffective. Incorrect: Saying, someone less deserving is saying that the mother may also be undeserving. This may hamper the goal of making sure she feeds hungry children. Incorrect: You can never be in someone elses shoes, and saying you can does not make it so. Correct: Focus upon the reason the community provides the coupons: to make sure her children are fed. REF: p. 87 OBJ: Cognitive Level: Comprehension

PTS: 1

6. Children with chronic illnesses, chronic conditions, or disabilities are often referred by community health nurses to which of the following programs to receive help with health care services?

a. NSAID Title I b. WECM ANS: C

Feedback A B C

c. CSHCN Title V d. WIC

Incorrect: NSAID Title I has nothing to do with chronic health conditions. Incorrect: WECM are the call letters for a popular radio station. Correct: Children with disabilities and those with chronic conditions can receive assistance with health care services through Title V Children with Special Health Care Needs (CSHCN). Incorrect: WIC is the Women, Infants, and Children nutrition program. REF: p. 87 OBJ: Cognitive Level: Knowledge

PTS: 1

7. Medicaid optional services most often include such things as: a. enhanced hospital coverage for intensive care b. housekeeping and maintenance services c. eyeglasses and speech, hearing, and dental care d. income for household expenses if time is lost on the job ANS: C
Feedback A B C D

Incorrect: Optional services do not include enhanced hospital coverage for intensive care. Incorrect: Optional Medicaid services do not cover housekeeping and maintenance services. Correct: Optional Medicaid services are determined by each state, and may include eyeglasses and speech, hearing, and dental care. Incorrect: Medicaid does not cover income for time lost on the job. REF: p. 87 OBJ: Cognitive Level: Comprehension

PTS: 1

8. Healthy People 2010 national health objectives added some new focus areas, two of which are: a. starting kindergarten and the reading initiative earlier to ensure reading by age six b. increasing small motor skills in children and reducing the incidence of behavioral problems in children c. involving fathers sooner in prenatal care and making certain they have an opportunity to be present at birth d. medical products safety and adding children to the maternal and infant safety area ANS: D
Feedback A B C D

Incorrect: Headstart programs focus upon early education programs. Incorrect: Healthy People 2010 is not focused upon small motor skills or reduced behavioral problems. Incorrect: Healthy People 2010 did not add this as an objective. Correct: Healthy People 2010 added Medical Product Safety and Access to Quality Health Services and Programs and included children in the maternal and infant priority areas. REF: p. 87 OBJ: Cognitive Level: Knowledge

PTS: 1

9. In the prevention of firearm-related injuries, the public health or community health nurse needs to: a. routinely inquire about the presence of firearms in the home and do a firearms safety assessment b. report all firearms seen on home visits to local child protective agencies so that agency can do a follow-up c. let families know he or she is opposed to keeping firearms in the home and insist they be removed d. schedule the family members (including the children in the home) for a gun safety clinic ANS: A
Feedback A

B C

Correct: As a key representative for community health, the nurse needs to routinely inquire about the presence of firearms in the home and teach safety to the parents and children. Incorrect: The presence of firearms in the home is not illegal. Incorrect: Individuals retain the right to have legal firearms in the home; the issue is keeping children safe in homes with guns. It is not appropriate for the nurse to express his or her opinion, not is it appropriate to insist firearms be removed. Incorrect: It is inappropriate for the community health nurse to schedule family members for a gun safety clinic. REF: p. 89 OBJ: Cognitive Level: Comprehension

PTS: 1

10. Which of the following tasks do community health nurses most often carry out in their work? a. administrating mammograms and teaching routine self-breast exams b. screening for venereal diseases and on-site microscopic analysis of samples from persons suspected of having these diseases c. assisting in obtaining serum lead levels and administering developmental assessments d. sonograms of the heart, bladder, uterus, or other organs as ordered by the clients public health care practitioner ANS: C
Feedback A B C

Incorrect: Community health nurses may be involved in screening programs such as teaching routine self-breast exams but would not administer mammograms. Incorrect: Community health nurses neither screen for venereal diseases nor perform onsite microscopic analyses of samples. Correct: Community health nurses have a major role in administering immunizations to children, assisting in measuring serum lead levels, and administering developmental assessments. Incorrect: Community health nurses do not perform sonography. REF: p. 90 OBJ: Cognitive Level: Comprehension

PTS: 1

11. In which of the following areas do community health nurses play a major role? a. measuring the quality of air in the home b. administering immunizations at clinics c. assisting with the identification of additional financial resources for nursing care d. informing the clients family of methods they should implement to enhance their standard of living

ANS: B
Feedback A B C D

Incorrect: Community health nurses do not play a major role in measuring the quality of air in the home. Correct: Community health nurses do play a major role in administering immunizations at clinics. Incorrect: Community health nurses do not play a major role in locating additional resources for nursing care. Incorrect: Community health nurses do not play a role in informing families about methods to improve their standard of living. REF: p. 89 OBJ: Cognitive Level: Comprehension

PTS: 1

12. The community health nurse would include in his or her assessments the: a. child and caregivers b. child, immediate family, and church c. child, childs family, any caregivers, and the school d. child, family, neighborhood, school, peer group, and community ANS: D
Feedback A B C D

Incorrect: A community assessment must include more than the child and caregivers. Incorrect: Headed in the right direction, but requires more still. Incorrect: Headed in the right direction, but requires more still. Correct: A community assessment must include the child, the family, the neighborhood, the school, peer groups, and community resources and agencies. REF: p. 91 OBJ: Cognitive Level: Knowledge

PTS: 1

13. A major goal of the community health nurses community assessment is to determine: a. how affluent the community is and how the family compares to the average in terms of income b. the influences of the larger environment on the childs and familys health and development c. how many churches and of what type are in the community and how the spiritual needs of the family are met d. how to get health care practitioners to accept nurse practitioners and to take Medicare assignments ANS: B
Feedback A B

C D

Incorrect: Affluence or lack of affluence is part of the consideration, but not a major goal. Correct: The nurses goal is to use knowledge gained during the community assessment to determine how the larger environment influences the health and development of the child and family. Incorrect: The churches are part of the larger environment, but are not a major aspect of community assessment. Incorrect: This is not a major goal of the community health nurse. REF: p. 91 OBJ: Cognitive Level: Application

PTS: 1

14. The community health nurse can perform a type of community assessment called a windshield survey in some texts. This survey is a(n): a. systematic assessment the nurse makes while driving through the community b. count of all the broken and cracked windshields in the community c. snapshot of people in the community in cars without seat belts fastened d. informal count of the number of babies not in properly positioned car seats ANS: A
Feedback A B C D

Correct: A windshield survey is a systematic assessment that is performed while the nurse travels through the community. Incorrect: The nurse should pay attention to the environment to assess risk factors for safety, but this option is not included in the survey. Incorrect: The nurse should pay attention to the environment to assess risk factors for safety, but this option is not included in the survey. Incorrect: The nurse should pay attention to the environment to assess risk factors for safety, but this option is not included in the survey. REF: p. 91 OBJ: Cognitive Level: Knowledge

PTS: 1

15. The community health nurse assesses the community for exposure to environmental toxins including radon, which is a: a. waste by-product of medical supplies not properly burned b. mold caused by a particularly deadly type of fungus c. groundwater contaminant derived from petroleum d. radioactive gas caused by decaying uranium ANS: D
Feedback A B C

Incorrect: Radon is not a waste by-product of medical supplies that have not properly burned. Incorrect: Radon is not a mold. Incorrect: The community health nurse may assess the community for toxins that contaminate groundwater, but radon is not a groundwater contaminate derived from petroleum. Correct: The community health nurse assesses the community for environmental toxins, including radon, which is a radioactive gas from decaying uranium. REF: p. 91 OBJ: Cognitive Level: Knowledge

PTS: 1

16. The community health nurse, in assessing for radon, keeps in mind that radon can cause: a. an increase in respiratory symptoms b. rare forms of cancer of the limbic system c. dwarfism d. loss of vision ANS: A
Feedback A

Correct: The community health nurse watches for all illnesses associated with environmental hazards such as radon, which can result in the increase of respiratory

B C D

symptoms and distress. Incorrect: Radon does not cause rare forms of cancer of the limbic system, but may be implicated in lung cancer. Incorrect: Radon does not cause dwarfism. Incorrect: Radon does not cause loss of vision. REF: p. 91 OBJ: Cognitive Level: Knowledge

PTS: 1

17. The community health nurse knows that radon can enter homes: a. through air-conditioning ducts c. by being tracked in on shoes b. through floors, cracks, and walls d. by animals carrying it ANS: B
Feedback A B

C D

Incorrect: Radon does not enter the home through the air-conditioning ducts. Correct: Radioactive uranium can exist in small quantities in the gravel used to make concrete. Where concrete is present in the floors and walls, cracks in the concrete provide a path for radon to enter the living spaces. Incorrect: Radon is not tracked inside on shoes. Incorrect: Radon is not being introduced into living spaces by animals. REF: p. 91 OBJ: Cognitive Level: Knowledge

PTS: 1

18. A community health nurse visits a child with exacerbation of asthma. The nurse would most likely assess for which one of the following in determining what is exacerbating the childs asthma? a. air pollution and secondhand cigarette smoke b. the childs height and weight c. the amount of exclusion the child is experiencing d. the educational level of the childs caregivers ANS: A
Feedback A B C D

Correct: Air quality is most often damaged by smog (air pollution) and second-hand cigarette smoke, which can exacerbate asthma. Incorrect: Asthma is not affected by a childs height and weight. Incorrect: Exclusion does not affect a childs asthma. Incorrect: The educational level of a childs caregivers may affect the childs asthma, but this is not the most likely causative factor. REF: p. 91 OBJ: Cognitive Level: Application

PTS: 1

19. When visiting a family in the community, the nurse finds that a toddler has some developmental delays. When looking for a cause or contributing factor, which of the following environmental factors would the nurse identify as being the most important to assess? a. presence of asbestos in the home b. animals in the home, particularly in the childs bedroom c. lead in paint and contaminated drinking water d. level of mold and dust mites in the childs play and sleeping areas ANS: C
Feedback

A B C D

Incorrect: Asbestos is implicated in respiratory issues, not developmental delays. Incorrect: Presence of animals is implicated in respiratory and other issues, not developmental delays. Correct: Developmental delays are caused by lead in paint and contaminated drinking water. Incorrect: Presence of mold and dust mites are implicated in respiratory issues, not developmental delays. REF: p. 91 OBJ: Cognitive Level: Application

PTS: 1

20. Families who are in the priority group for lead poisoning screening include those with children between the ages of: a. birth and 5 months c. 7 and 10 years b. 6 months and 6 years d. 11 and 18 years ANS: B
Feedback A

Incorrect: Lead paint poisoning requires ingestion, and infants from birth to 5 months are unlikely to be able to ingest lead paint chips, because teething does not begin until 5 to 7 months of age. Correct: Lead poisoning is most prevalent between the ages 6 months to 6 years. Lead enters a childs body most commonly by ingestion of loose lead-based paint chips or hand-to-mouth behaviors via contaminated hands, fingers, toys, pacifiers, etc. Incorrect: Lead enters a childs body most commonly by ingestion of loose lead-based paint chips or hand to mouth behaviors via contaminated hands, fingers, toys, pacifiers, etc.These behaviors are typically not seen in 7- to 10-year-olds. Incorrect: Lead enters a childs body most commonly by ingestion of loose lead-based paint chips or hand-to-mouth behaviors via contaminated hands, fingers, toys, pacifiers, etc.These behaviors are not seen in 11- to 18-year-olds. REF: p. 91 OBJ: Cognitive Level: Comprehension

PTS: 1

21. When doing a household environmental assessment, the community health nurse discovers that the family has a closet full of chemicals. The nurse would teach the family to do which of the following things? a. Discard all the chemicals, as the safety of children supersedes any need for chemical use. b. Use the chemicals only if the children are taken out of the area where the chemicals are being used. c. Minimize the number of chemicals, lock the closet, and use proper ventilation when any chemicals are used in the house. d. Have the children and pets checked for chemical poisoning immediately. ANS: C
Feedback A B C

Incorrect: It is not necessary to discard the chemicals, but they must be kept out of reach of children. Incorrect: Proper ventilation is adequate in most cases to allow chemical use in the presence of children. Correct: Use chemicals and pesticides infrequently, reduce the number in the house, keep them locked away, and always use proper ventilation when used in the presence of children. Incorrect: Having children and pets checked for chemical poisoning is not necessary.

PTS: 1

REF: p. 91

OBJ: Cognitive Level: Comprehension

22. In communities where there is high risk for lead poisoning, community health nurses working in clinics assist in getting blood from children for lead level screenings by which of the following methods? a. arterial blood draw c. an ear stick b. venous blood draw d. a finger stick ANS: D
Feedback A B C D

Incorrect: Arterial blood draw is not necessary to test for lead. Incorrect: Venous blood draw is not necessary to test for lead. Incorrect: An ear stick is not necessary to test for lead. Correct: Routine lead-level screenings can be done with a finger stick. REF: p. 92 OBJ: Cognitive Level: Knowledge

PTS: 1

23. When the nurse discovers that a child has been exposed to lead and the childs lead levels are elevated, the nurse will first: a. tell the family to seek medical attention for the child immediately b. discover the source of the lead poisoning and keep the child from getting more c. give the child the universal antidote for lead poisoning d. call the state health department and seek information ANS: A
Feedback A

B C D

Correct: Because lead can be removed from the body, the nurses first action is to tell the family to seek immediate medical attention if the child has been exposed and lead levels are elevated. Incorrect: Locating the lead source and keeping the child away from it is a very important action, but not the first. Incorrect: There is not a universal antidote for lead poisoning. Incorrect: Seeking medical attention immediately is the first action. Calling the state health department and seeking further information would be done later. REF: p. 92 OBJ: Cognitive Level: Application

PTS: 1

24. The presence of lead in the central nervous system will cause: a. bleeding in the ventricles of the brain b. the release of large amounts of adrenocorticotropic hormone (ACTH) by the anterior pituitary, which leads to systemic dysfunction c. an increase in membrane permeability causing a fluid shift into brain tissue d. seizures and the risk for status epilepticus ANS: C
Feedback A B C

Incorrect: Lead causes a fluid shift into the brain tissues, not bleeding in the ventricles. Incorrect: Lead in the central nervous system causes serious damage in the brain, some say irreversible damage. The pituitary is not affected. Correct: Lead causes an increase in membrane permeability, causing a fluid shift into

brain tissue, producing increased intracranial pressure, ischemia, and cellular destruction. Incorrect: Seizures may result, but should not to be confused with status epilepticus. REF: p. 92 OBJ: Cognitive Level: Comprehension

PTS: 1

25. Only which of the following methods can remove lead from the body? a. light therapy c. blood exchanges b. chelation therapy d. forcing of fluids ANS: B
Feedback A B C D

Incorrect: Light therapy cannot remove lead from the body. Correct: Lead can be removed from the body only by chelation therapy, which must be performed under the care of a specialist. Incorrect: Blood exchange cannot separate the lead from the brain tissue or central nervous system. Incorrect: Forcing of fluids cannot separate the lead from the brain tissue or central nervous system. REF: p. 92 OBJ: Cognitive Level: Knowledge

PTS: 1

26. The four major change agents that impact the future of community health care for children and families are demographics, science, and: a. the stock market and recession periods b. hospital administrative policies and health care reimbursement c. market-driven economic policy and technology d. the amount of influence the public has on legislators and the political party in power ANS: C
Feedback A B C

Incorrect: The stock market and recession periods may benefit or undermine funding for community health care, but these are not among the four major change agents Incorrect: Hospital administrative policies and health care reimbursement may effect community health care, but are not among the four major change agents. Correct: The four major change agents that impact the future of community health care for children and families are market-driven economic policy, technology, demographics, and science. Incorrect: The amount of influence the public has upon the party in power or legislators is not one of the four major change agents. REF: p. 93 OBJ: Cognitive Level: Knowledge

PTS: 1

27. Some of the demographic changes impacting community health care have meant that there are: a. fewer diseases, as people are building a greater immunity through exposure to diverse populations b. more children living in poverty conditions and without health care insurance c. more nurses who understand the cultural needs of people than there are jobs for such nurses d. clear policies in health care facilities on dealing with the cultural needs of people ANS: B

Feedback A B C D

Incorrect: As people can catch an airplane and fly over the oceans to our shores, we face more diseases, not fewer. Correct: As population growth continues, the demographic changes mean there are more children living in poverty conditions and without health care insurance. Incorrect: As demographic changes occur, the number of jobs for nurses who understand cultural diversity is greater than the numbers of such nurses available. Incorrect: Clearly the policies of health care facilities need to reflect demographic changes and cultural diversity, but the changes do not guarantee or create clear policies. REF: p. 93 OBJ: Cognitive Level: Knowledge

PTS: 1

28. Which of the following activities by the home health nurse best exemplifies primary prevention? a. home infant phototherapy c. pediatric hospice services b. home antibiotic referral services d. teaching new mothers infant care ANS: D
Feedback A B C

Incorrect: Home infant phototherapy is secondary prevention in which the goal is to reverse or reduce the severity of diseases. Incorrect: Home antibiotic referral services is an example of secondary prevention. Incorrect: A pediatric hospice means the client has been removed from the home for care in a health care facility that infers long-term services. Pediatric hospice services are an example of tertiary prevention. Correct: Primary prevention involves interventions for children that promote health and prevent disease processes from developing. Teaching new mothers how to perform infant care best exemplifies primary prevention. REF: p. 93 OBJ: Cognitive Level: Comprehension

PTS: 1

29. Which of the following activities by the home health nurse best exemplifies secondary prevention? a. short-term home visits to teach diabetes care to a person who is diabetic and has a small foot ulcer b. immunizations of infants and preschool children c. private duty nursing at night for an elderly couple who manage alone during the day d. nursing care for children who are technologically dependent ANS: A
Feedback A

B C D

Correct: In order to intervene with early diagnosis and treatment, secondary prevention aims to detect disease in the early stages before clinical signs and symptoms manifest. The goal is to reduce the severity of a disease or provide a cure. Short-term nursing visits to teach diabetes care to a person with diabetes with a small foot ulcer best exemplifies secondary prevention. Incorrect: Immunizations are intended to prevent diseases, hence, are examples of primary prevention. Incorrect: A private agency can provide this service, community home health care does not. Incorrect: Nursing care for children who are technologically dependent is an example of tertiary preventive care.

PTS: 1

REF: p. 93

OBJ: Cognitive Level: Knowledge

30. Tertiary care by the home health nurse is directed toward children with: a. minor problems c. short-term needs b. clinically apparent disease d. problems in mobility ANS: B
Feedback A B

C D

Incorrect: Tertiary prevention aims to improve the course of a disease, reduce disability from a disease, or rehabilitate. These are not minor problems. Correct: Tertiary prevention is directed toward children with clinically apparent disease. Tertiary prevention aims to improve the course of a disease, reduce disability from a disease, or rehabilitate. Incorrect: Tertiary prevention aims to improve the course of a disease, reduce disability from a disease, or rehabilitate. These are long-term needs. Incorrect: Tertiary prevention aims to improve the course of a disease, reduce disability from a disease, or rehabilitate. Problems in mobility may arise, but solutions for mobility are not central to tertiary care. REF: p. 93 OBJ: Cognitive Level: Comprehension

PTS: 1

31. Managed care systems are most concerned with which of the following areas of interest? a. quality of care c. cost containment b. satisfaction of recipients of care d. quick referrals to specialists ANS: C
Feedback A B C D

Incorrect: Managed care systems measure quality of care, but this is not the highest concern. Incorrect: Managed care systems measure recipient care satisfaction, but this is not the highest concern. Correct: Managed care systems are most concerned with cost effective delivery of health care services, i.e., cost containment. Incorrect: Quick referrals to specialists is not a path to cost containment. REF: p. 93 OBJ: Cognitive Level: Knowledge

PTS: 1

32. The need for comprehensive home care programs for children was largely created by: a. caregivers demanding that children be cared for at home whenever possible b. health care practitioners and nurses who felt the hospital was likely to create more infections than the home c. managed care supporting early discharges as a cost-effective measure d. the Joint Commission on Accreditation of Healthcare Organization because of the understaffing of nurses in hospitals ANS: C
Feedback A B C

Incorrect: Most caregivers prefer that their children be cared for away from home. Incorrect: The incidence of infections from the hospital is not the driver for expanding comprehensive home care programs for children. Correct: Managed care, by supporting early discharges from hospitals, has created a

need for comprehensive home care programs for children. Incorrect: Comprehensive home care programs have increased the demand for nurses and added to the understaffing in hospitals. REF: p. 93 OBJ: Cognitive Level: Comprehension

PTS: 1

33. The children who receive the majority of hours of service by home health nurses are those who are: a. technologically dependent and those who require hospice care b. in need of medications through intravenous lines c. on tube feedings requiring the nurse to teach this skill to caregivers at home d. in need of cast care, dressing changes, tracheostomy care, or other nursing skills ANS: A
Feedback A B C D

Correct: Children who are dependent on technology and those who need hospice care receive the majority of home care nursing hours. Incorrect: The majority of hours of service by home health nurses are not for clients in need of medications through intravenous lines. Incorrect: The majority of hours of service by home health nurses are for clients on tube feedings, which requires the nurse to teach this skill to caregivers at home. Incorrect: The majority of hours of service by home health nurses are not for clients need of cast care, dressing changes, tracheostomy care, or other nursing skills. REF: p. 93 OBJ: Cognitive Level: Knowledge

PTS: 1

34. In working with a child and the childs family, the nurse has an interpersonal relationship with the child and family that is best described as: a. authoritarian c. supervisory b. collaborative d. friendship ANS: B
Feedback A B

C D

Incorrect: The nurses interpersonal relationship in working with the child and family is not best described as authoritarian. Correct: Interpersonal relationships among the home care nurse, the child, and family can best be described as collaborative--where mutual sharing and working together help to achieve common goals such that all persons or groups are recognized and growth is enhanced. Incorrect: The nurses interpersonal relationship in working with a child and family is not best described as supervisory. Incorrect: The nurses interpersonal relationship in working with the child and family is not best described as friendship. REF: p. 94 OBJ: Cognitive Level: Knowledge

PTS: 1

35. Which of the following activities by the home health nurse will help in maintaining professional boundaries? a. avoiding sharing of any personal information b. alternating home visits with another nurse c. discussing the case with an unbiased nursing colleague d. clarifying roles early in the home visits

ANS: D
Feedback A

B C D

Incorrect: Maintaining professional boundaries does not require the avoidance of sharing of any personal information. A boundary is crossed when self-disclosure is excessive. Incorrect: Each nurse must maintain professional boundaries separately, and this is not affected by alternating home visits with another nurse. Incorrect: Maintaining professional boundaries does not disallow discussing the case with an unbiased nursing colleague. Correct: Professional boundaries are defined as the space between the nurses power and the clients vulnerability. Clarifying roles early can assist the home care nurse to ensure these boundaries are maintained. REF: p. 94-5 OBJ: Cognitive Level: Knowledge

PTS: 1

36. Which of the following behaviors by the nurse would lead you to suspect the nurse had crossed the professional boundaries with a family in his or her caseload? a. disclosing personal details such as being single and available b. establishing house rules such as where to store belongings and where to park and defining routines c. listening to various family members talk about their needs and feelings d. letting the family have their wishes, being flexible, and encouraging the family to participate in care ANS: A
Feedback A

B C D

Correct: Home health care nurses should recognize signs that they have crossed boundaries, including excessive self-disclosure, secretive behavior, super nurse behavior, selective communication, flirtations, and failure to protect the client. Incorrect: To ensure the establishment of professional boundaries, house rules should be established, such as where to store belongings and to park a car, plus defining routines. Incorrect: To ensure the establishment of professional boundaries, the nurse will insist upon listening to various family members talk about their needs and feelings. Incorrect: Letting the family have their wishes, being flexible, and encouraging the family to participate in care will facilitate and maintain a professional working relationship. REF: p. 95 OBJ: Cognitive Level: Knowledge

PTS: 1

37. A child asks the home health nurse to skip (omit) one of his treatments and play a game with him. The nurse visit is scheduled for 1 hour and that is all that he or she is being paid for by the home health agency. The best response by the nurse is which of the following? a. Yes, I can do that, as you are far more important to me than this treatment. b. I am the home health nurse. I give treatments and I cant play games. c. Let me ask your mother if she will have time to play a game with you later. d. Lets see if we can finish the treatment and still have time to play a short game. ANS: D
Feedback A

Incorrect: The treatment comes first, and, if time allows, a game is permitted as long as the scheduled time is maintained.

B C D

Incorrect: This is to be thought, perhaps, but left unsaid: harsh and inhuman. Incorrect: The child has asked you, the nurse, to play the game, not the mother. Correct: Home care nurses are professionals who are there to help maintain health. If the home care nurse can set up a schedule that ensures treatment protocols are being carried out, it may be possible to have some time to play a game. REF: p. 95 OBJ: Cognitive Level: Application

PTS: 1

38. Each nurse-client relationship can be plotted on a continuum of professional behavior according the National Council of State Boards of Nursing (1996). One end of the continuum is overinvolvement, such as boundary crossings, and the other end of the continuum is referred to by the National Council of State Boards of Nursing as: a. professionalism c. burnout b. underinvolvement d. noncaring ANS: B
Feedback A B

C D

Incorrect: Between overinvolvement and underinvolvement, professionalism may be found. It is not on the ends, but in the center. Correct: The continuum of professional behavior ranges from underinvolvement (distancing, disinterest, and neglect) to overinvolvement (boundary crossings and boundary violations). The zone of helpfulness is in the center of the continuum. Incorrect: Burnout may lead to underinvolvement, but burnout is not the other end of the continuum with overinvolvement. Incorrect: Noncaring is a serious issue for nursing professionalism and may lead to underinvolvement, but noncaring is not the other end of the continuum with overinvolvement. REF: p. 95 OBJ: Cognitive Level: Knowledge

PTS: 1

39. When the home health nurse engages in distancing, disinterest, or neglect in interactions with the children and families in his or her assigned caseload, the nurse is said to be in what location on the continuum of professional behavior? a. underinvolvement c. zone of helplessness b. overinvolvement d. burnout zone ANS: A
Feedback A B

C D

Correct: Underinvolvement is signified by distancing, disinterest, or neglect in interactions with the children and families in an assigned caseload. Incorrect: Overinvolvement is described as excessive self-disclosure, plus casual, social conversations, and the family incorporating the nurse as a member of the family. This can be a serious problem for home health nurses. Incorrect: The zone of helpfulness is midway between underinvolvement and overinvolvement. Incorrect: Overinvolvement can put the home care nurse at risk for burnout, requiring the nurse to withdraw for personal care. REF: p. 95 OBJ: Cognitive Level: Knowledge

PTS: 1

40. The home health nurse is doing home visits with a child whose family seems to be reducing the stress of having a stranger in the home by treating the nurse like a member of the family. This situation is:

a. b. c. d.

very therapeutic to the family placing the nurse at risk for boundary violation going to make the nurses working conditions easier likely to help the child deal with the trust issue more easily

ANS: B
Feedback A B C D

Incorrect: Without maintaining healthy professional boundaries, therapy cannot be provided to the client or the family. Correct: A nurse may become overinvolved and lose professional status when being treated like just another member of the family. Incorrect: The working conditions may seem easier, but the conditions required for a therapeutic professional nursing relationship cease to exist. Incorrect: The trust issue depends upon the therapeutic professional nursing relationship. REF: p. 95 OBJ: Cognitive Level: Comprehension

PTS: 1

41. The home health nurse is assigned to make home visits to a child. During the initial assessment, the nurse learns the childs family needs a service that can be provided by a company that the nurse and his or her significant other own. The best action on the part of the nurse is to: a. advise the family of this company the nurse owns and suggest they try it b. advise the family of the company and suggest they compare services and prices with similar companies c. say nothing to the family about the company the nurse owns and leave their choice up to chance d. avoid any separate business dealings with the family in addition to the relationship of home health nurse ANS: D
Feedback A

Incorrect: The blurring of professional boundaries, combining home care nursing with a referral to your partners business will cause overinvolvement and violate the zone of helpfulness. Incorrect: The blurring of professional boundaries, combining home care nursing with a referral to your partners business will cause overninvolvement and violate the zone of helpfulness. Incorrect: Better, but the blurring of professional boundaries, combining home care nursing with a referral to your partners business will cause overninvolvement and violate the zone of helpfulness. Correct: The nurse should always act in the best interests of the child and family, and avoid any separate business dealings with the family in addition to the relationship of home health nurse. REF: p. 95 OBJ: Cognitive Level: Application

PTS: 1

42. The home health nurse assesses the needs of a family that is caring for an ill child at home and finds the family needs respite care. Which of the following descriptions best defines respite care? a. short-term temporary relief for the caregiver(s) so they can get rest and renewed energy b. a type of group home care that allows the client a break from the family c. care in a rehabilitation center so the client can be rehabilitated d. a type of relief care that permits the home health nurse to use personal benefits, such as

vacation, while not burdening the family ANS: A

Feedback A

B C D

Correct: Respite care is short-term, temporary care that is normally provided in the home for a child who requires specialized care; it provides relief for caregivers, which may help to prevent burnout and increase the caregivers ability to cope with stress. Incorrect: The respite care occurs in the childs home. Incorrect: The respite care occurs in the childs home. Incorrect: The respite care is provided for the primary caregivers, not the nurse. REF: p. 95 OBJ: Cognitive Level: Knowledge

PTS: 1

43. The nurse has been caring for a child in the home who has a tracheostomy and is oxygen dependent. The nurse wants to do the care in the morning due to the geographic location of the seven children in the caseload. The family requests the care be done after lunch because it fits their schedule better. Select the best response by the nurse. a. Im sorry. It is impossible for me to do this in the afternoon. I wish I could, but I cannot. b. If I give the care in the afternoon, it means that six other childrens schedules have to be rearranged and that is not fair to them. c. Lets look at what time is in the childs best interest and then at what you and I can change to better accommodate that. d. I will see if the home health agency can find another nurse who can meet your preferred schedule. ANS: C
Feedback A B C D

Incorrect: The home care nurse needs to respect the familys wishes and be flexible, so this is not the best response. Incorrect: The home care nurse needs to respect the familys wishes and be flexible. This is not the best response. Correct: The nurse should always act in the best interests of the child and the family. This is the best response. Incorrect: The home care nurse needs to respect the familys wishes and be flexible and should not find another nurse to meet the family schedule. REF: p. 95 OBJ: Cognitive Level: Comprehension

PTS: 1

44. The home health nurse would accurately describe his or her practice compared to a nursing practice in the acute hospital as: a. very similar c. the same b. somewhat similar d. very different ANS: D
Feedback A B C

Incorrect: The home visit requires nursing practice that is very different from the hospital setting. Incorrect: The home visit requires nursing practice that is very different from the hospital setting. Incorrect: The home visit requires nursing practice that is very different from the hospital setting.

Correct: Although both hospital-based nurses and home health care nurses use acutecare and high tech skills, the home visit requires nursing practice that is very different from the hospital setting. REF: p. 96 OBJ: Cognitive Level: Knowledge

PTS: 1

45. Home health care for children is becoming increasingly more complex requiring nurses to: a. have more continuing education requirements b. have five or more years of acute care prior to entry c. be competent in high-technology care d. provide intensive care for only one or two clients ANS: C
Feedback A B C D

Incorrect:The number of CE requirements does not equal the technical skill involved in home health care for children. Incorrect: The number of years of acute care does not equal the technical skill involved in home health care for children. Correct: The dimensions of home care for children are becoming more complex, requiring nurses to be competent in high tech care. Incorrect: The case load for the home care nurse is limited by time, not the type of care. REF: p. 96 OBJ: Cognitive Level: Knowledge

PTS: 1

46. The case management approach to home health care includes which relationship among the health care practitioner, family, home care providers, and case managers? a. directive c. free exchange b. authoritative d. collaborative ANS: D
Feedback A B C D

Incorrect: The directive approach is not appropriate for home health care case management. Incorrect: The authoritative approach is not appropriate for home health care case management. Incorrect: The free exchange approach is not appropriate for home health care case management. Correct: The case management approach includes a collaborative effort that takes place among the health care provider, family, home care providers, and case managers. REF: p. 97 OBJ: Cognitive Level: Knowledge

PTS: 1

47. Hitchcock et al. (2003) described the three phases of the home visit of a nurse as: a. contact, interact, and react b. preinteraction, engagement and active participation, and termination c. learning, application of what is learned, and point of evaluation d. focusing, planning, and resolution ANS: B
Feedback A

Incorrect: Contact, interact, and react are not the three phases of the home visit

C D

according to Hitchcock et al. (2003). Correct: Following the initial phone call, Hitchcock et al. (2003) describes the three phases of the home visit: 1) preinteraction; 2) engagement/active participation; and 3) termination. Incorrect: Learning, application of what is learned, and point of evaluation are not the three phases of the home visit according to Hitchcock et al. (2003). Incorrect: Focusing, planning, and resolution are not the three phases of the home visit according to Hitchcock et al. (2003). REF: p. 97-8 OBJ: Cognitive Level: Knowledge

PTS: 1

48. What preparation should the home health nurse do prior to making the first home visit to the family of a child assigned to him or her? a. identification of the location of the home and available parking b. determination of what equipment is needed c. contact with the health care practitioner and family, review of family data, and neighborhood assessment for environmental factors d. criminal background checks on the neighbors, property values in the neighborhood, and a financial assessment of family ANS: C
Feedback A B C

Incorrect: Preinteraction is not only the identification of the location of the home and available parking, but much more. Incorrect: Preinteraction is not concerned with the determination of what equipment is needed. Correct: The preinteraction phase is involved in preparation prior to the first home visit, and includes contact with the health care practitioner and family, review of family data, and neighborhood assessment for environmental factors that may affect personal safety. Incorrect: Preinteraction does not require criminal background checks on the neighbors, property values in the neighborhood, and a financial assessment of family. REF: p. 98 OBJ: Cognitive Level: Knowledge

PTS: 1

49. You are the nurse assigned to make several home visits in one day. What would you do with your valuables (e.g., purse or wallet and jewelry) and medical supplies during the day? a. lock valuables and all supplies not needed (for any one visit) in the trunk of your car and leave jewelry at home b. get a lockable suitcase on wheels to put the valuables in and wheel everything around with you c. carry all valuables with you in a disclosed location and request that the head of household escort you to and from your car d. call the local police station and arrange for a police escort to the family home if you have any concerns about your valuables ANS: A
Feedback A

Correct: When traveling to make a home visit keep valuables, including medical supplies, locked in the trunk of your car, out of sight. Carry a cellular phone in the car at all times, and ensure that it is in working order. Avoid wearing jewelry. Incorrect: A lockable suitcase would have to be lifted into and out of the trunk, not a

C D

great idea. Incorrect: Lock all valuables in the trunk, and carry only the supplies necessary for the home visit. Incorrect: The local police should only be summoned in the case of emergency. REF: p. 98 OBJ: Cognitive Level: Comprehension

PTS: 1

50. In a home visit to the family of an active 15-month-old, the home health nurses priority in giving anticipatory guidance would be which of the following? a. providing instructions about potty training b. selecting a day-care center or in-home nanny so the mother can return to work c. locking low cabinets and getting gates on the stairways to the second floor d. selecting educational toys and materials for this developmental age ANS: C
Feedback A

B C D

Incorrect: The nurses priority in giving anticipatory guidance for an active 15-monthold should focus on safety, as a child at this age has an inquisitive, active mind and walks with an unsteady gait. Incorrect: A home visit is focused upon care in the home, not out of the home. Correct: The assessment of the home environment will include education about agespecific safety measures to be followed in a childs home. Incorrect: A home visit is not focused upon selecting educational toys and materials for this developmental age. REF: p. 98 OBJ: Cognitive Level: Application

PTS: 1

51. You are assigned to make a home visit to the family of a 7-year-old boy. You learn from reading the childs file that the family practices the orthodox Jewish faith. Your best course of action would be to: a. let the family know you are not of this faith so the family will be understanding if you breach the family customs b. research the orthodox Jewish faith prior to the family visit and inquire of the family about their practices and expectations of you prior to the visit c. share with the family that you dont know much about their religious faith but you respect them d. start attending a synagogue so you can become enculturated in the Jewish faith ANS: B
Feedback A B

C D

Incorrect: If the familys cultural customs are breached, it may prevent the nurse from being able to interact effectively with the child and family. Correct: An awareness of and respect for the cultural, religious, and ethnic diversity of families is essential to gaining trust. The home health care nurse should review available family data. Incorrect: It would be better not to say anything about a religious faith you know nothing about. Saying you do not know is the opposite of showing respect. Incorrect: Family practices of the orthodox Jewish faith can be learned from a book. REF: p. 99 OBJ: Cognitive Level: Application

PTS: 1

52. As a home health nurse, you would try hard not to breach the cultural customs of the family you are visiting. The best rationale for avoiding such a breach is which of the following?

a. b. c. d.

You more likely might be sued if you breach the cultural customs. It might prevent you from being effective in interactions with the child and family. Such actions are fundamental to effective nursing practice. The family would otherwise hold a grudge, thus preventing you from interacting with the client and family members.

ANS: B
Feedback A B

C D

Incorrect: Fear of being sued is not the best rationale for avoiding a breach in cultural customs. Correct: The nurse should inquire about social customs usually practiced, such as removing shoes or avoidance of eye contact, which may be considered impolite. If these customs are breached, it may prevent the nurse from being able to interact effectively with the child and the family. Incorrect: Basically true, but not the answer sought. Incorrect: The family holding a grudge against the home care nurse will not be able to trust the home care nurse. REF: p. 99 OBJ: Cognitive Level: Application

PTS: 1

53. A home health nursing supervisor is assigned to observe a home health nurse during the daily assignment. During each visit, the supervisor observes the nurse engaging in social conversations with the child and family. The most likely explanation for this nurses behavior is which of the following? a. facilitating rapport b. engaging in a possible boundary violation c. trying to be a friend instead of a nurse d. filling extra time ANS: A
Feedback A B C D

Correct: Engage in social conversation to facilitate rapport, as the nurse is often viewed as a guest by the child and family. Incorrect: Boundary violations require excessive self-disclosure. Social conversations do not require excessive self-disclosure. Incorrect: Social conversations can lead to friendship, but can also just be friendly used to facilitate rapport. Incorrect: Social conversations that are filling time are not a great idea when the supervisor is with you. REF: p. 101 OBJ: Cognitive Level: Application

PTS: 1

54. You are the nurse making a home visit to a child and the childs family. The home is very cluttered with such items as clothing, newspapers, old mail, soda bottles, and take-out food bags and cartons. Your best response to this clutter is to: a. be careful to restrict any response to one that is nonjudgmental b. tell the caregivers they need to clean this up or you may need to report them to child protective services c. get the caregivers to write a schedule of chores for themselves and all of the children d. provide the caregivers with the names of some cleaning services ANS: A

Feedback A B C

Correct: The best response is to be nonjudgmental about the condition of the home (e.g., presence of clutter or disarray). Incorrect: This response would not establish rapport or be providing culturally sensitive nursing care. Incorrect: A clue to the familys cultural values and norms may include how they assign family roles, tasks, and chores. It is inappropriate for the nurse to get the caregivers to write a schedule of chores. Incorrect: This response would not establish rapport or be providing culturally sensitive nursing care. REF: p. 101 OBJ: Cognitive Level: Application

PTS: 1

55. Children diagnosed with complex medical problems and who are technologically dependent are usually most at risk for which of the following? a. sexual abuse c. eating disorders b. psychological abuse d. developmental delays ANS: D
Feedback A B C D

Incorrect: Children who have complex medical conditions are not at risk for sexual abuse at a higher rate than any other child. Incorrect: Children who have complex medical conditions are not at risk for psychological abuse at a higher rate than any other child. Incorrect: Children who have complex medical conditions are not at risk for eating disorders at a higher rate than any other child. Correct: Children who have complex medical conditions, are dependent on technology, and are being cared for in the home may be at risk for developmental delays and problems. REF: p. 99 OBJ: Cognitive Level: Knowledge

PTS: 1

56. A home health nurse is made aware that a client and family are about to lose their home due to foreclosure. The nurse contacts the social service department of the home health care agency for assistance in finding housing for the family. The actions taken by the nurse best exemplify which of the following roles of the community health nurse? a. clinician c. researcher b. advocate d. consultant ANS: B
Feedback A B C D

Incorrect: The roles of clinician is a role associated with community health nursing. However, the role of the advocate is most applicable to the scenario provided. Correct: The advocate identifies the needs and desires of the family, while attempting to intervene effectively. Incorrect: The roles of researcher is a role associated with community health nursing. However, the role of the advocate is most applicable to the scenario provided. Incorrect: The roles of consultant is a role associated with community health nursing. However, the role of the advocate is most applicable to the scenario provided. REF: p. 86 OBJ: Cognitive Level: Application

PTS: 1

57. Which of the following teaching activities would be considered primary prevention? a. educating parents on the signs of lead poisoning b. educating parents on the importance of routine immunizations c. providing families with the number for the poison control hotline d. educating parents on first aid for insect bites ANS: B
Feedback A B C D

Incorrect: Educating parents on the signs of lead poisoning is an example of secondary prevention. Correct: Educating parents on the importance of obtaining routine immunizations is an example of primary prevention. Incorrect: Providing families with the number for the poison control hotline is another example of secondary prevention. Incorrect: Teaching first aid for insect bites to parents is not an example of primary prevention. REF: p. 93 OBJ: Cognitive Level: Application

PTS: 1

58. Which of the following statements made by the clients family indicates they have been properly educated on respite care? a. Respite care will provide coverage for us while our current home care nurse attends a conference. b. Respite care will allow us to take a much needed vacation without worrying about who will care for our child. c. Respite care will allow our ill child to attend the public school with other children of similar age. d. Respite care is designed to be a cost-effective option to intensive home care services. ANS: B
Feedback A B C D

Incorrect: Respite care is not associated with coverage for the nurse typically assigned to the case. Correct: Respite care is short-term, temporary care that provides relief for the caregivers. Incorrect: Respite care is not associated with the child attending the public school system. Incorrect: Respite care is not considered an alternative to intensive home care services. REF: p. 95 OBJ: Cognitive Level: Application

PTS: 1

59. A public health nurse is actively seeking to establish partnerships with health care practitioners and has been offering to establish a consortium of public health nurses in the area. To which of the following standards of professional performance is the nurse contributing? a. quality of care c. performance appraisal b. education d. collegiality ANS: D
Feedback A

Incorrect: While quality of care is one standard of professional performance, it is not associated with the establishment of partnerships or the contribution to the professional

development of others. Incorrect: While education is one standard of professional performance, it is not associated with the establishment of partnerships or the contribution to the professional development of others. Incorrect: While performance appraisals are a standard of professional performance, they are not associated with the establishment of partnerships or the contribution to the professional development of others. Correct: Collegiality involves the establishment of collegial partnerships and contributes to the professional development of colleagues and others. REF: p. 97 OBJ: Cognitive Level: Application

PTS: 1

60. Which of the following nursing actions is associated with the provision of tertiary prevention activities in the home care setting? a. services provided to a child who is ventilator-dependent b. educating an adolescent on the use of an insulin pump c. teaching the clients family how to monitor a surgical incision for signs of infection d. demonstrating how to effectively wash an infant ANS: A
Feedback A

B C D

Correct: Tertiary care activities are directed toward children who have clinically apparent disease. Providing services to a child who is ventilator-dependent would be one such activity. Incorrect: Educating an adolescent on the use of an insulin pump is an example of secondary prevention. Incorrect: Teaching a client how to monitor a surgical incision for signs of infection is an example of secondary prevention. Incorrect: Demonstrating how to effectively wash an infant is an example of primary prevention. REF: p. 93 OBJ: Cognitive Level: Application

PTS: 1

61. Home care nursing has become increasingly specialized due to the need for technologically advanced care. Which of the following standards has been implemented for nurses working in home care? a. competency-based curricula b. mandatory completion of continuing education units c. entry at the Bachelor of Science in Nursing (BSN) level or higher d. recent intensive-care experience ANS: A
Feedback A

B C D

Correct: According to the text, competency-based curricula have been developed for home care nurses to update their skills or learn new skills. Such activities are typically part of the home care agencys orientation program for nurses Incorrect: Mandatory completion of continuing education units is not one of the standards of home health nursing practice. Incorrect: Entry at the Bachelor of Science in Nursing (BSN) level or higher is not one of the standards of home health nursing practice or working in home care. Incorrect: Recent intensive-care experience is not one of the standards of home health nursing practice.

PTS: 1 MULTIPLE RESPONSE

REF: p. 96

OBJ: Cognitive Level: Application

1. A pediatric client has hearing and vision testing completed at school. Such assessments are examples of which of the following? Select all that apply. a. health protection c. Healthy People 2010 objectives b. disease prevention d. health promotion ANS: A, B, C, D
Feedback Correct

Incorrect

a., b., c., and d are correct. According to the text, health protection activities are designed to maintain the current level of health, actively prevent disease, detect disease early, and maintain functioning. Disease prevention would also be appropriate, as this refers to activities designed to protect persons from disease. Healthy People 2010 objectives also include the goal of reducing blindness and visual impairments in adolescents, thus making screening exams in school an appropriate intervention. Vision and hearing testing would also be an appropriate health promotion activity. Thus, all responses are correct. All responses are correct. REF: p. 87-90 OBJ: Cognitive Level: Application

PTS: 1

2. Which of the following activities would be considered part of the engagement and active participation phase of home care nursing? Select all that apply. a. review of the clients previous records b. assessment of the safety of the general living environment c. evaluation of the caretakers ability to assume responsibility for the child d. evaluation of electrical sources, including a backup electrical source if the client is ventilator-dependent ANS: B, D
Feedback Correct

Incorrect

b. and d. are correct. During the engagement and active participation phase of home care nursing, the nurse will assess the safety of the living environment. The nurse will also assess electrical sources, including backup electrical sources for ventilator-dependent children. a. and c. are incorrect. In the preinteraction phase, the nurse will review the clients previous records. In the termination phase, the nurse will evaluate the caregivers ability to assume responsibility for the child. REF: p. 100 OBJ: Cognitive Level: Application

PTS: 1